Semen and Urine Culture in the Diagnosis of Chronic Bacterial ...

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Chronic Bacterial Prostatitis Table 2 – Clinical and demographic differences among symptomatic and asymptomatic patients. Age in years (SD) Symptomatic Patients N = 70 36.6 Asymptomatic Patients N = 17 41.1 p Value = 0.08 More than one sexual partner Background of UTI Partner with leucorrhea Total NIH-CPSI score(SD) N % 08 11.59 61 87.1 20 28.6 19.9 (7.97) N % 2 11.6 0 =0 8 47 6.8 (5.6) p Value = 0.98 < 0.001 = 0.15 < 0.001 Physical exam Abdominal pain Pain in the penis Right testis pain Left testis pain Pain in the prostate N % 11 15.7 09 12.9 04 05.7 09 12.9 08 11.4 N % 0 00 0 00 3 17.6 2 12 3 17.6 p Value 0=0.08 0=0.12 0=0.1 0=0.1 0=0.5 SD = standard deviation, UTI = urinary tract infections, NIH-CPSI = National Institute of Health – Chronic Prostatitis Symptom Index. 33.8% to 56.6%), specificity of 94% (95% CI 74.2% to 99%), a likelihood ratio associated with a positive semen culture of 8.1 (95% CI 1.2 to 55.3), and likelihood ratio associated with a negative semen culture of 0.6 (95% CI 0.5 to 0.7). Figures-1 and 2 show how the post-test probability of having CBP varies compared to the different pre-test probabilities (clinical suspicion) according to the likelihood ratios. The performance of the urine culture in relation to the Meares and Stamey test is shown in Table -5. We found a sensitivity of 4.3% (95%CI 1.5% to 12%), a specificity of 100% (CI 82.4% to 100%), an infinite likelihood ratio of a positive urine culture and a 0.96 (95% CI 0.9 to 1) likelihood of a negative urine culture. Finally, the leukocyte count per high power field in expressed prostatic secretions showed that 64 Table 3 – Laboratory results in symptomatic and asymptomatic patients. Laboratory Results Symptomatic Patients N = 70 Asymptomatic Patients N = 17 Meares and Stamey test Positive Negative N % 67 95.7 03 04.3 N % 02 11.8 15 88.2 p Value < 0.001 < 0.001 Leukocyte count (SD) 24.9 (11.3) 6.2 (8.4) p Value Semen culture Positive Negative Leukocyte count (SD) N % 31 44.3 39 55.7 0 6.44 (7.34) 1.8 (2.83) N % 01 05.9 16 94.1 < 0.001 = 0.01 33
Chronic Bacterial Prostatitis Table 4 – Semen culture results vs. Meares and Stamey test. Meares and Stamey Semen Culture Positive Negative Total Positive 31 1 32 Negative 38 17 55 Total 69 18 87 Sensitivity: 45% (33.8% - 56.6%), Specificity: 94% (74.2% - 99%), LR (+): 8.1 (1.2 - 55.3), LR (-): 0.6 (0.5 - 0.7). LR: Likelihood ratio, LR (+): Is the ratio of the proportion of patients with chronic bacterial prostatitis (CBP) with a positive semen culture, to the proportion of non-diseased males who also had a positive result., LR (-): Is the ratio of the proportion of patients with CBP with a negative semen culture, to the proportion of non-diseased males who also had a negative result. (91.4%) of the symptomatic males and only 2 (11.7%) of the controls had prostatic inflammation according to our criteria (p < 0.001). When we changed our parameters to 5 or more leukocytes per high power field, the number of patients with inflammation increased to 67 (95.7%) and 7 (41.1%) respectively (p < 0.001). The leukocyte count mean in the EPS sample from the symptomatic patients was significantly higher than in asymptomatic males; 24.9 (± 11.3) vs. 6.2(± 8.4), p < 0.001. No other significant difference was seen at the time we compared the leukocyte counts in the other samples obtained in this study. COMMENTS In our sample, 77% of patients had CBP according to their symptoms and results in the Meares and Stamey test. The semen and urine cultures revealed limited diagnostic properties. Our results argue that a negative semen culture is not an adequate test to rule out CBP, particularly in patients with high pre-test probability (i.e., men with classic symptoms). On the other hand, a positive semen culture greatly increases the post-test probability of CBP and may orient the choice of antibiotic therapy obviating the need for the cumbersome reference standard test. Figures-1 and 2 help the clinician determine how the likelihood ratios associated with the semen culture results determine the post-test probability of Figure 1 – Post-test probability determined by the Likelihood ratio of a positive semen culture (8.1), in patients with varying pre-test probabilities. 34
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